In recent years, there has been a decline in the rates of trabeculectomy and a rise in rates of aqueous shunts and microinvasive glaucoma surgeries. , There is concern amongst glaucoma surgical educators that low trabeculectomy volumes during training are exacerbating this trend. 
The purpose of this cross-sectional survey study was to survey recently graduated glaucoma specialists and explore how surgical volume during training, success and complication rates, practice setting, and other patient population factors might influence practice patterns of recently graduated glaucoma specialists. 
A survey was distributed to the American Glaucoma Society’s “Young Glaucoma Specialists” listserv, and 66 responses were received from members completing training within the past 5 years (2018-2022). 
Sixty four respondents (93.9%) reported feeling somewhat or entirely comfortable performing trabeculectomy as a result of their training. However, 42 (63.6%) said that they do not often perform trabeculectomy, whereas only 13 (19.7%) reported that they do. 
Respondents were offered a list of factors that might influence their choice to perform trabeculectomy and selected the degree to which they agreed with each. Those who reported performing trabeculectomy often (N = 13) were influenced by the surgery’s high success rates (92.3%), its preoperative (76.9%) and intraoperative (84.6%) processes, and low postoperative complications (61.5%). Those who reported not performing trabeculectomy often (N = 42) were most discouraged by the postoperative process of trabeculectomy, as well as the socioeconomic (66.7%) and sociocultural (52.4%) characteristics of their patients. Factors such as volume performed during training (47.6%), cost-effectiveness (19.0%), and reimbursement rates (19.0%) were not considerable contributors. 

While the majority of young glaucoma specialists in our study report being comfortable performing trabeculectomy as a result of their training, the majority stated that they do not often perform trabeculectomy in practice. Notably, low trabeculectomy surgical volume during training was not cited as an notable barrier, whereas patient factors and preference for alternative procedures, depending on the clinical scenario, appeared to drive this trend.

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